| Research Purpose:Through investigating the status of nutritional support and care about the ICU critical patients,to understand the clinical medical staff on the latest guidelines for the implementation of nutritional support,find out the ICU critical patients nutrition support and nursing problems existing in the process of the insufficiency,analysis the reason and put forward improvement suggestion and nutritional support for improving ICU critical patients and nursing strategies to provide clinical basis and theoretical reference.Research Methods:Through literature research and expert consultation methods,referring to relevant research published at our country or abroad and "ESPEN Intensive Care Unit Clinical Nutrition Guide",the contents of the questionnaire survey were established,and a questionnaire for the implementation of nutrition support and care of critically ill patients was designed.Using convenient sampling methods,we conducted a survey on ICU / EICU critically ill patients admitted to the First People's Hospital of Huzhou from July 2019 to December 2019 to collect general patient information,APACHE-? scores,nutrition assessment tools and nutrition evaluation results,classification of acute gastrointestinal injury,implementation of nutritional support and care during the patient's stay in the ICU / EICU,gastrointestinal tolerance,laboratory test results,and clinical outcomes at 28 days.The survey tools are the patient general information questionnaire,the nutritional support implementation and nursing questionnaire for critically ill patients,and the nutritional implementation questionnaire after the patients enter the ICU.Research Results:1.The patients admitted to ICU / EICU are mainly elderly men over 60 years old.Their marital status is mainly married.The educational level is mostly junior high school or below.The length of hospital stay is mainly short-term hospitalization.22 cases with APACHE-? score <20 points(14.5%),75 cases(49.3%)with 20-30 points,55 cases(36.2%)with> 30 points,and the overall condition was moderately intensive.2.All 152 patients in this study underwent a nutritional risk assessment using mNutric score.There were 86 patients(56.7%)with high nutritional risk(5-9 points)and 66 patients(43.4%)with low nutritional risk(0-4 points).Nutritional support was provided to 71(46.7%)patients at high nutritional risk and to 46(30.3%)patients at low nutritional risk.3.152 patients in this study,There are 141(93%)patients have the assessment of gastric bowel function,normal(AGI0)47 cases(33%),mild damage(AGI?level)67 cases(48%),severe damage(AGI ?-?)18 cases(13%),failure(AGI?)9 cases(6%).4.The number of patients receiving nutritional support was 117 cases,with a nutritional support rate of 77%,including 67(44%)patients receiving EN+PN combined feeding,37(37%)patients receiving TEN support,13(9%)patients receiving TPN support,and 35(23%)patients haven't receive nutritional support.5.Among the 117 patients receiving nutritional support,47(40.2%)patients reached the standard within 72 hours(including 72 hours)after the initiation of EN support,41(35.0%)patients reached the standard of nutritional support after 72 hours,and 29(24.8%)patients failed to meet the standard.6.Among the 104 patients receiving EN support,73 patients(70.2%)had EN start time ?48 hours,and 31 patients(29.8%)had EN start time> 48 hours.There were 38 cases(36.6%)of people who met the standard within 72 hours(including 72 hours)after the start of EN support,25 cases(24.0%)who met the standard more than 72 hours after the start of EN support,and 41 patients who did not meet the standard(39.4%).7.In the main feeding routes of EN,96(92.3%),1(0.9%),7(6.7%)and 0(0%)patients were respectively fed through the gastric feeding pathway,the post pyloric feeding pathway,the jejunostomy tube and the PEG/J pathway.In the infusion of EN,3 cases(2.9%),101 cases(97.1%)and 0 cases(0%)were given in batches,continuous infusion and gravity infusion,respectively.8.In 104 patients with EN support,the position of the gastric tube was determined before feeding and the head of the bed was always raised during EN feeding.In 86(83%)patients,the head of the bed was raised at 30°-45° during EN support,consistent with the guidelines.The highest frequency of feeding interruption was medical treatment(256 times(62%),followed by EN intolerance(154 times(37%),and finally by other causes(6%).9.The 117 patients with nutritional support,only 15(13%)received parenteral micronutrients and/or antioxidants,32(27%)received parenteral/parenteral glutamine,and only 10(9%)received additional vitamin D.10.There was no statistically significant difference between HB,TP,ALB,TF,PA,and TLC within 24 hours(before nutrition support)of patients with TEN,TPN,EN + PN and patients without nutrition support(p> 0.05).There was no statistically significant difference between HB,TP,TLC and ALB on the 7th day of hospital admission(after nutrition support)for patients with TPN,EN + PN and no nutritional support(p> 0.05),and there was Statistically significant between PA and TF(p <0.05).Use the LSD method for post-mortem analysis of statistically significant items,and obtain a pairwise comparison result.The TF level of patients receiving TEN is higher than other patients,and the difference is statistically significant(p <0.05),patients receiving TEN and EN + PN had higher PA than those without nutritional support,and the difference was statistically significant(p <0.05).11.The incidence of infection was 40.2% in patients with nutritional support and 62.9% in patients without nutritional support,The incidence of complications was 40.2% in patients with nutritional support and 57.1% in patients without nutritional support.The 28-day mortality of patients with nutritional support was 26.7%,and the 28-day mortality of patients without nutritional support was 45.7%.There was no significant difference in the incidence of complications between patients with nutritional support and patients without nutritional support(p> 0.05);the 28-day mortality and infection rate of patients with nutritional support were lower than those without nutritional support,the difference was statistically significant Significance(p <0.05).Research Conclusion:At present,the vast majority of ICU critically ill patients have received nutritional support,and the basic nutritional support strategies are consistent with the guidelines,but there is a gap between them in terms of specific implementation :(1)insufficient application of nutritional assessment.(2)delay in EN in some patients.(3)about a quarter of the patients had nutritional support below the standard.This may be related to the patient's gastrointestinal intolerance and frequent interruption of feeding.(4)patients with gastrointestinal disorders did not receive personalized evaluation when applying PN support,indicating that the symptoms were too loose.Therefore,the following Suggestions are put forward :(1)timely reassessment according to the changes in the patient's condition,especially for patients with high nutritional risk,should appropriately increase the frequency of reassessment,for patients with a sharp decline in the disease should also be timely reassessment.(2)it is suggested to form a multidisciplinary nutrition support group to make clinical decisions on the timing,approach and management plan of nutrition support,and to conduct regular education and training for all the medical staff involved in nutrition support.(3)advice form nutrition support operation process checklist,nutrition pump adopt the specialized subject specialist is responsible for the centralized management mode,for early EN intolerance,gastrointestinal dysfunction,and other complications,et al,we should form a set of standardized assessment and treatment process,and organize regular education and training department,guarantee in the process of nutrition support do early detection,correct processing.When necessary,individualized nutrition strategies and standardized nutrition nursing procedures should be formulated for patients,and training of clinical medical personnel should be strengthened to improve the efficiency of nutrition support. |
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